Increased Risk of Myocardial Infarction in HIV-Infected Individuals in North America Compared With the General Population.

Pubmed ID: 28520615

Pubmed Central ID: PMC5522001

Journal: Journal of acquired immune deficiency syndromes (1999)

Publication Date: Aug. 15, 2017

MeSH Terms: Humans, Male, Adult, CD4 Lymphocyte Count, Female, HIV Infections, Risk Factors, Middle Aged, Risk Assessment, Proportional Hazards Models, Comorbidity, Incidence, Viral Load, Myocardial Infarction, Anti-HIV Agents, Antiretroviral Therapy, Highly Active, North America

Grants: UL1 TR000083, UM1 AI068634, P30 AI027763, KL2 TR000421, R01 AA016893, U01 AI069434, U01 AI037984, R01 DA011602, U01 AI031834, P30 AI094189, R01 DA026770, U01 AI035004, G12 MD007583, U01 AI037613, U01 AI035041, R24 AI067039, R56 HL126538, U01 AI069432, K01 AI071754, F31 DA035713, U10 EY008052, U01 AA020790, K01 AI093197, U01 AI069918, U01 AA013566, R01 HL126538, R56 AI102622, U01 AI034993, U01 AI035039, U24 AA020794, U01 AI068634, P30 AI050410, UL1 TR001863, P30 AI027767, U01 AI035042, P30 MH062246, K01 AI070001, K23 EY013707, R01 CA165937, UM1 AI069432, P30 AI054999, Z01 CP010176, U01 AI038855, U54 MD007587, R01 DA004334, UL1 RR024131, U01 AI034989, ZIA CP010214-01, N02CP55504, U01 AI038858, U10 EY008057, U01 AI068636, U01 AI034994, M01 RR000052, U01 AI035043, P30 AI027757, R01 DA012568, U01 AI035040, Z01 CP010176-05, U10 EY008067, P30 AI036219, U01 HD032632, U01 AI042590, KL2 TR002317, R01 AG053100

Authors: Zhang J, Moore RD, Heckbert SR, Post WS, Drozd DR, Kitahata MM, Althoff KN, Gange SJ, Napravnik S, Burkholder GA, Mathews WC, Silverberg MJ, Sterling TR, Budoff MJ, Van Rompaey S, Delaney JAC, Wong C, Tong W, Palella FJ, Elion RA, Martin JN, Brooks JT, Jacobson LP, Eron JJ, Justice AC, Freiberg MS, Klein DB, Saag MS, Crane HM

Cite As: Drozd DR, Kitahata MM, Althoff KN, Zhang J, Gange SJ, Napravnik S, Burkholder GA, Mathews WC, Silverberg MJ, Sterling TR, Heckbert SR, Budoff MJ, Van Rompaey S, Delaney JAC, Wong C, Tong W, Palella FJ, Elion RA, Martin JN, Brooks JT, Jacobson LP, Eron JJ, Justice AC, Freiberg MS, Klein DB, Post WS, Saag MS, Moore RD, Crane HM. Increased Risk of Myocardial Infarction in HIV-Infected Individuals in North America Compared With the General Population. J Acquir Immune Defic Syndr 2017 Aug 15;75(5):568-576.

Studies:

Abstract

BACKGROUND: Previous studies of cardiovascular disease (CVD) among HIV-infected individuals have been limited by the inability to validate and differentiate atherosclerotic type 1 myocardial infarctions (T1MIs) from other events. We sought to define the incidence of T1MIs and risk attributable to traditional and HIV-specific factors among participants in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) and compare adjusted incidence rates (IRs) to the general population Atherosclerosis Risk in Communities (ARIC) cohort. METHODS: We ascertained and adjudicated incident MIs among individuals enrolled in 7 NA-ACCORD cohorts between 1995 and 2014. We calculated IRs, adjusted incidence rate ratios (aIRRs), and 95% confidence intervals of risk factors for T1MI using Poisson regression. We compared aIRRs of T1MIs in NA-ACCORD with those from ARIC. RESULTS: Among 29,169 HIV-infected individuals, the IR for T1MIs was 2.57 (2.30 to 2.86) per 1000 person-years, and the aIRR was significantly higher compared with participants in ARIC [1.30 (1.09 to 1.56)]. In multivariable analysis restricted to HIV-infected individuals and including traditional CVD risk factors, the rate of T1MI increased with decreasing CD4 count [≥500 cells/μL: ref; 350-499 cells/μL: aIRR = 1.32 (0.98 to 1.77); 200-349 cells/μL: aIRR = 1.37 (1.01 to 1.86); 100-199 cells/μL: aIRR = 1.60 (1.09 to 2.34); <100 cells/μL: aIRR = 2.19 (1.44 to 3.33)]. Risk associated with detectable HIV RNA [<400 copies/mL: ref; ≥400 copies/mL: aIRR = 1.36 (1.06 to 1.75)] was significantly increased only when CD4 was excluded. CONCLUSIONS: The higher incidence of T1MI in HIV-infected individuals and increased risk associated with lower CD4 count and detectable HIV RNA suggest that early suppressive antiretroviral treatment and aggressive management of traditional CVD risk factors are necessary to maximally reduce MI risk.